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General NPI Number Information
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NPI Number | 1245735497
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Entity Type | Individual
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Provider Name | GREGORY MICHAEL JENNINGS APRN
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 8444 SUMMERLIN DR
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City | LONGMONT
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State | CO
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Zip | 80503-3906
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Country | US
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Telephone | 720-577-5251
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Fax | 720-780-7057
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Provider Business Mailing Address
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Address Line | 1120 SHACKELFORD RD
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City | FLORISSANT
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State | MO
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Zip | 63031-4369
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Country | US
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Telephone | 314-830-5805
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Fax | 314-830-5806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2018003488
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209017407
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License Number State | IL
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